Interventions to reduce overcrowding in emergency departments: An umbrella review

To identify and evaluate the effectiveness of interventions and/or strategies to reduce overcrowding in Emergency Departments (EDs).

An umbrella review was performed using the JBI method. Eight search resources were considered. Two independent reviewers carried out the selection of studies, quality assessment, data extraction, and synthesis.

Twenty systematic reviews were included, which identified several interventions to reduce overcrowding in EDs, such as: joint triage (physicians and nurses); creation of fast tracks; introduction of Rapid Assessment Units; request for auxiliary diagnostic tests by nurses; streaming; collaboration with Primary Health Care (PHC) for referral of non-urgent cases; allocation of PHC units within or adjacent to EDs; triage by PHC professionals; extension of PHC hours; increase in hospital capacity; creation of full capacity protocols; hiring of specialist professionals; lean thinking; reverse triage. The most effective interventions and/or strategies were: joint triage; creation of fast-track routes; introduction of rapid assessment units; request for auxiliary diagnostic tests by nurses; streaming; and collaboration with PHC for referral of non-urgent cases.

The combination of effective triage, appropriate flow management, and proactive action by the team appears to be key to mitigating overcrowding in the EDs. Joint triage and fast-track routes are the most effective measures. The expanded role of nurses - including their ability to request examinations and manage rapid assessment units - is also crucial to speeding up care.